Title: Numb Lip: A Rare Presentation of Breast Malignancy

Background
Paraesthesia of the lip is a rare but known symptom of malignancy and bone metastatic disease. However, it is commonly attributed to Orofacial, dental or neurological pathology, so thorough investigation is important for a definitive diagnosis.
Methods
A 62-year-old female presented to our Oral and maxillofacial Surgical unit after referral from her dentist. She complained of a sudden onset of numbness to her right lower lip, deteriorating to complete anaesthesia of the lower lip and chin. Background medical history included hypertension, cystic kidney disease and diverticular disease.
Examination demonstrated that the numbness was limited to the region supplied by mental nerve, not crossing the medline. Initial radiographic investigation with OPG was negative for any dental or orofacial pathology. Further investigation with MRI was performed.
Result
MRI demonstrated multiple lesions within the cranium, cervical spine and right ramus of the mandible, involving the proximal mental foramen keeping with metastatic disease. Laboratory tests were positive for breast Cancer. Mammogram demonstrated well circumscribed nodule in the lateral right breast.
Conclusion:
This case report highlights the importance of comprehensive clinical examination and investigations within a multidisciplinary approach for patient assessment. Malignancy as a differential diagnosis should be always considered in unexplained lip and chin numbness.